The Surgery Journey

• Learn as much as you can about the surgery and what will happen during recovery and rehabilitation.
• Practice with any mobility devices you’ll be using after surgery.
• Eat a nutritious, well-balanced diet – stay hydrated, eat more fibre and foods high in Vitamin C, calcium, and iron.
• Be as fit as possible to help you recover quickly.
• Perform exercises to help strengthen your joints and reduce muscle soreness and fatigue that might result from the use mobility devices.
• For hip or knee surgery, strengthen your leg muscles by walking regularly.
• Complete any recommended pre-operative (pre-op) exercises twice a day .
• Quit smoking – smoking increases your risk of getting a serious infection after surgery. 
• Reduce alcohol use – You should not exceed 14 drinks per week (men) or seven drinks per week (women).
• Ensure you are up-to-date on vaccinations (such as the flu vaccine).
• Bring a friend or family member to your pre-op meeting with the surgeon.

• Arrange for meals during your recovery period (e.g. freeze meals that can easily be reheated during the first week or two after surgery).
• Avoid shaving for 5 days before and 2 weeks after surgery to avoid small cuts in the skin that can harbor bacteria and lead to infection.
•  Attend any pre-operative teaching sessions arranged by your surgeon/hospital and follow the instructions. For example, you may need to contact a clinic to schedule your post-operative physiotherapy sessions once you know your surgical date.
•  Attend any required pre-op appointments and tests (blood tests, cardiogram, x-ray).
• The surgical team may advise you to stop certain medications (e.g. nonsteroidal anti-inflammatory drugs, blood thinners, medications used to treat rheumatologic conditions, etc.) prior to surgery. If you have questions about any of your medications, ask your surgeon.
• If you are taking opioid pain medications, your doctor may advised that you reduce the dose as much as possible or slowly discontinue use before surgery. Patients who are taking these medications before surgery tend to have more trouble managing their pain after surgery. 
• You will be advised to stop taking most supplements, such as multi-vitamins (check with your surgeon).
• Remind family and friends of the date of the surgery so they can support if needed.
• Set up your home so that you can sleep on the same floor you spend most of your day – this will help avoid the use of stairs after your surgery.
• Move furniture, rugs and mats to avoid tripping.
• If needed, install a raised toilet seat and/or get a bedside commode (a chair with built-in bed pan).
• Add a small sitting stool for the shower and a non-skid mat for your bathtub or shower.
• Move items you’ll use often to an easy-to-access location.
• Plan how you’ll get the mail, handle laundry, prepare meals, etc. after your operation.
• Arrange for family and friends to look after any pets and/or plants during surgery and recovery.
• Use armchairs during recovery to support you when you sit down and stand up.
• Arrange your bed so that the height of the mattress isn’t too low or too high.
• Have a dental evaluation and address any dental issues before surgery.
• Report any illness leading up to surgery to your surgeon. You should also tell your surgeon if you have any open sores on your body. If you have an infection elsewhere in your body, your surgery may need to be delayed to reduce the risk of developing a serious infection in the new joint. 

• A list of all your current medications.
• Your health card.
• The name, phone number and address of your pharmacy.
• An up-to-date contact list of family, friends, and your family doctor for caregivers and your healthcare team.
• The names of other healthcare professionals involved in your arthritis care, along with their addresses, phone and fax numbers.
• An up-to-date list of medication allergies, dietary restrictions and food allergies.
• Loose, comfortable clothes to wear in hospital and for the trip home.
• Supportive shoes that you can easily slip into.
• If you wear glasses, contact lenses, a hearing aid or dentures, be sure to bring a case to put them in, labelled with your name and phone number.
• Personal hygiene items such as a toothbrush, shampoo, soap, deodorant, wet wipes, and a razor (no shaving of the incision area for at least 2 weeks after the operation).

• Take a shower/bath the night before, wash thoroughly with anti-bacterial soap.
• Avoid lotions, powders, shaving.
• Sleep in clean pajamas on freshly laundered sheets the night before surgery.
• Remove any make-up, lipstick, and/or nail polish before going to hospital.
• On the morning of surgery, you can have clear fluids (such as apple juice, sports drinks, etc.) up to 3 hours before surgery to help you stay hydrated.
• Be sure your hospital bag is packed and ready to go.

In some cases, surgery can be done as an outpatient procedure, without an overnight hospital stay. If there is a hospital stay involved, it is usually one or two days.

Surgery can take 1 to 2 hours or more, depending on the affected area and type of surgery
 

An intravenous (IV) line will be inserted into a vein in your arm or hand to give you fluids and required medicine during surgery

You will receive an anaesthetic and/or sedative which will make you sleep through the surgery.
 

Your vital signs such as heart rate and blood pressure will be monitored to ensure surgery can proceed safely

This is done when other treatments have not worked and joint function is limited. It involves surgery to resurface or replace the ends of bones in a damaged joint to create new joint surfaces. The artificial joint (prosthesis) is usually made of metal and plastic, which is fitted to the end of the bones in the affected joint to replace the worn-out joint surface. The prosthesis may be kept in place using bone cement or through a coating that encourages bone growth onto the implant. The joints most often replaced are the hip, knee, and shoulder. Other joints such as the elbow and ankle can also be replaced.

An incision is made over the affected area.
 

The surgeon removes the damaged areas of bone and cartilage around the joint.
 

The joint surface is replaced with metal and plastic components.
 

The incision is closed and a dressing applied.

This procedure fuses two bones together in a damaged joint. The result is a joint that no longer moves, which reduces pain by eliminating movement between the damaged joint surfaces. Fusion procedures are most commonly used to treat arthritis of the spine, ankles, hands and feet. 

An incision is made at the affected area. 
 

The surgeon removes damaged cartilage and bone, removing the joint surfaces. 
 

The bones on either end of the joint are fused together. Metal implants such as pins, plates and screws as well as bone grafts may be used to stabilize the bone ends to ensure healing. Pins are often later removed. 

The incision is closed and a dressing applied. 

An osteotomy involves cutting and realigning a bone. This is done to correct certain deformities, especially around the hip and knee. By realigning the joint, abnormal forces in the joint can be reduced, slowing down the progression of arthritis. In most cases, osteotomies are done in active younger people who want to delay surgery to replace a hip or knee joint. 

An incision is made at the affected area. 
 

The surgeon cuts the affected bone. 
 

The bone is realigned to correct the shape and reduce abnormal forces through the joint. 
 

The bone is then secured using pins and/or plates and screws until the bone has healed in the new position. If needed, a bone graft (a small piece of bone) is added. 

The incision is closed and a dressing applied. 

Other procedures may be indicated in some cases and you should discuss the details with your surgeon. 

Your IV remaining in for a period of time after surgery to deliver pain medicine and sometimes other medicines as needed 

Measures taken to manage swelling, such as compression stockings (for hip and knee surgery) 
 

Learning deep breathing exercises to prevent lung congestion 
 

Learning how to move around safely after surgery and learning how to use a mobility aid, if required. You may also learn to do exercises that will help with your recovery (e.g. bending and straightening your leg after knee replacement surgery).

Learning how to manage your pain safely after surgery. Adequate pain control means that you are able to look after yourself and do your usual daily tasks. In addition to medications, you will also use techniques such as icing and elevating the affected area to minimize pain.

Using a variety of different techniques to manage pain will help you to avoid or minimize the need for strong opioid pain medications during recovery. 

Most surgery patients will be ready for discharge within one to two days or even on the day of surgery. Generally, you will be able to leave the hospital when your vital signs are normal, your pain is controlled, you can tolerate food and you are able to move around safely. Additionally, your care team will ensure you can manage daily activities such as bathing and dressing during your recovery. 

Any surgery comes with a risk of complications. This might be due to prior health issues, the anesthetic you receive, or the stress on your body from undergoing surgery. Here are a few things you can do to help prevent or diminish complications: 

• Infection - infections in the skin around the wound or inside the affected joint are rare, but can be very serious when they occur. If you develop a serious infection, you may require additional surgery. You can do the following things to reduce your risk of infection: 
  • Be well-nourished (patients who are either very thin or who are very overweight are at increased risk of infection) 
  • Quit smoking (at least 6 weeks prior to the surgery date) 
  • If you are diabetic, ensure your blood sugar is well controlled (check with your family doctor if you are unsure) 
  • Take your pre-operative shower with chlorhexidine soap (prescribed by your surgeon or provided by your hospital) 
  • Listen to and follow the instructions provided to care for your wound after surgery. 
• Anemia (lack of healthy red blood cells) – to reduce the risk of low hemoglobin levels when you lose blood during surgery, get your body in the best shape for surgery beforehand.  Your hemoglobin level should be tested before surgery and if it is low, it should be addressed before surgery to reduce the risks associated with transfusion (receiving blood), which may increase risk of other complications. Your doctor may suggest taking an iron supplement before and/or after surgery. If your hemoglobin is very low, you may need to take other medications to build it up before surgery. 
• Blood clots – these can develop after surgery, especially in people with other risk factors or who are inactive. Be sure to move frequently and perform activities that increase blood circulation. If you have joint replacement (hip or knee) surgery, you will need to take a medication to prevent blood clots for at least two weeks after surgery. 
• Lung complications – fluid in the lungs or pneumonia could result from prolonged bed rest. Be sure to remember to take deep breaths regularly and get out of bed and move as soon as you can after surgery. 
• Delirium – sometimes a period of confusion can occur after surgery. There are several causes for this, but one of the most common causes is the use of opioid medications for pain management. To help reduce the chance of delirium, minimize how much strong opioid pain medication you take. If you wear glasses or hearing aids, remember to use these so you can safely interact with your surroundings. 
• Pain – opioids are powerful medications that may be used to manage your pain after surgery, but they come with significant side effects. For some larger surgeries, you may need to use opioids for a brief period of time after surgery. However, you should always use a combination of other pain medications (such as acetaminophen and anti-inflammatory medications) to address your pain first and only use strong opioid medications if necessary. To reduce the risk of overdose or abuse, you should use opioid medications in the smallest possible dose for the shortest possible time. 
• Other complications can occur with specific surgeries. Be sure to speak with your surgeon before planning a surgery to make sure that you understand all of the potential risks of surgery as well as the likely benefits. 

It’s important to return to regular physical activity as soon as possible after your joint replacement, once you’ve received approval from your healthcare team. You’ll be discharged from the hospital with exercises to aid your recovery, so complete them 3 to 5 times every day. You will need to ease back into movement, starting with the exercises provided by your care team.  Over time, you will progress to increasing the use of your joint over longer periods of time.  Make sure to only engage in activities approved by your care team and don’t try to do too much too soon. Keep a log of your daily exercise routine and share this with your care team.

If the surgery was on your hip or knee, you should walk every day and take lots of breaks. Both rest and exercise are very important for your recovery. In the first few weeks after surgery, you will probably get tired quickly. Rest when you feel tired and break up or pace your activities throughout the day.

Continue your prescribed exercises until you begin therapy with a physiotherapist or occupational therapist. Your therapist will work with you to create a rehabilitation program that will optimize your recovery and help to strengthen your muscles and joint. Additional exercises will also be given to stretch any tight muscles and other tissues, as well as help improve your balance if it was affected by the surgery. You should continue to use mobility aids or assistive devices until your therapist or surgeon advises you to stop.

Once approved by your care team, low-to-moderate intensity activity should be done 4 to 7 days a week. These activities should be low impact, allowing for periods of rest and they should not cause joint pain. Low impact activities include: walking, swimming, light bicycling on flat roads, stationary bicycling, or golfing (except in the case of shoulder surgery, which will require a longer recovery time before returning to activities such as golf). Ask your surgeon when it is safe to resume recreational activities and sports.

If you require assistive devices, continuing using them as recommended by your physiotherapist or occupational therapist. Depending on the joint, you may need to keep canes or walkers on hand for longer walks or for extra support during your recovery. 

After surgery, your doctors and nurses will make every effort to control your pain. Adequate pain control means that you are able to look after yourself and do your usual daily tasks with (near) full independence. In addition to a variety of pain relief medications, there are different techniques to manage pain in order to avoid or minimize the need for strong opioid medications during recovery. 

Pain Management Techniques 

There are many methods that can help you manage your pain after surgery: 

• Reducing swelling can help minimize pain. You can reduce swelling by elevating the affected joint and applying ice, four times a day, for 15-20 minutes at a time. 
• For weight-bearing joints, maintaining a healthy weight will reduce stress on the joint and pain. 
• Maintain your prescribed exercises to help reduce swelling and inflammation. Slight pain is acceptable, but don’t push to the point of severe pain.  If the exercises are causing severe pain, consult with your health care team.   
• Mindfulness, a thinking activity that focuses your attention and feelings of being present and in the moment, can help reduce anxiety and overcome pain. Mindfulness allows you to put your pain in perspective and draw your attention to other sensations. 
  

Medications 

Many types of medicines are available to help control pain and make you feel more comfortable, allowing you to start moving sooner, get your strength back more quickly, and recover from surgery faster. Medication should be taken as soon as you begin to feel pain, not when it becomes severe. Always follow the instructions on the prescription labels and do not exceed the recommended dose. It is normal to feel some pain after surgery. The goal should be to manage your pain so that you can function well, rather than aim or expect to be completely pain-free as soon as possible. 

Medication Types  

• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or acetylsalicylic acid, reduce swelling and soreness and can be used for mild to moderate pain. NSAIDs can reduce or eliminate your need for opioid medications and do not lead to dependence/addiction. Taken on their own, they may not fully relieve moderate to severe pain that you may experience after surgery. 
• Acetaminophen is a pain-relieving drug (analgesic) that does not have anti-inflammatory properties and works well for mild to moderate pain.  Acetaminophen can be taken safely in combination with an NSAID medication, as they work to reduce pain through different mechanisms. Taking both medications together can help more than taking either one on their own and may reduce your need for strong opioid pain medications. 
• Opioids are powerful pain medications used for severe pain. These medications have significant side effects and can be addictive.  You may only need to use opioids for a brief period of time after surgery, if at all. A combination of other pain medications and pain management techniques should be used first, and strong opioid medications should only be taken if necessary. To reduce the risk of overdose or abuse, you should use opioid medications in the smallest possible dose for the shortest possible time after surgery.  

Every medication can have side effects, and you should talk with your doctor or pharmacist about all your medications to avoid any harmful reactions. 

Taking care of your surgical incision is an important part of your recovery. There may be some drainage from the cut within the first week after surgery.  If there is any drainage after one week, you should contact your surgeon. Here are some tips to help you take care of your incision: 

• Look at the cut every day. Check to make sure it is not infected. If it is infected, it might be very red or there could be pus around the cut or a lot of liquid leaking from it.  As noted, a small amount of liquid drainage is normal in the first few days after surgery. 
• Keep the cut clean and dry. Do not rub or scratch the cut or the area around it. 
• You can take a shower or sponge bath. Take off the bandage before you bathe. Wash yourself with soap and water. Let water run over the cut. Do not rub or scrub your staples or stitches. 
• When you are clean, pat the cut dry with a clean towel. Do not put any cream, lotion or oil on your cut. Put a new bandage on once the area is totally dry. 
• Do not soak in a bath, pool or hot tub until your staples or stitches have been removed, your cut is completely healed and there is no scab remaining. 

Keys to maintaining the long-term success of your new joint are to maintain your therapeutic exercises and avoid high-impact activities. For instance, if you had knee replacement surgery, jogging may be too high-impact for the new knee. These kinds of activities can increase wear-and-tear between the components of your new joint, which are made of materials like ceramic or metal and plastic. Aim for lower-impact exercises and activities, like walking or swimming. Golfing may be fine for some joints, but you should not return to golf immediately after shoulder replacement. As with any new exercise routine, talk to your doctor first.

If your new joint is weight-bearing, you can minimize stress on it by managing your weight. Excess weight can increase strain on the foot, ankle, knee or hip joints, and can also impact your hands, wrists, elbows and shoulders. The additional tension could, over time, cause loosening of a joint replacement.

Infections can occur in artificial joints many years after the original surgery. Once you have had a joint replaced, you should always be more careful if you develop a systemic or local infection affecting any part of your body and you should let the healthcare professionals caring for you know that you have an artificial joint. In rare occasions, bacteria from an infection somewhere else in your body can spread to the artificial joint and cause it to become infected, which can be very serious and may even require surgery. Treating problems such as skin and dental infections rapidly can help to reduce the risk of developing an infection in your artificial joint.

You should also follow up with your surgeon every two to five years after surgery to check on your joint. To prepare for these follow-up appointments, keep track of any changes in function or mobility, or new symptoms worth noting. Take the opportunity to ask about long-term functioning and to discuss any concerns you have with your surgeon. It is important that you see your surgeon right away if you have any new symptoms, pain or dysfunction in the operated joint.

• Stand up straight, holding on to a kitchen counter or sturdy table top.
• Rise up on your toes by lifting your heels as high as possible.
• Slowly lower your heels back on to the floor.
• Perform up to 3 sets of 8 to 15 repetitions.

• Lie on your back with your legs straight and toes pointed upwards towards the ceiling.
• Bend one knee and point the foot and toes of your other leg toward your head.
• With the straight leg, tighten the muscles in the front of your thigh and push the back of your knee into the bed.
• Relax, and repeat.
• After 8 to 15 repetitions, switch legs.

• Lie on your side with the affected leg upwards and your good leg on the bed with knee slightly bent
• Wrap a resistance band snugly around your knees. Start with minimal resistance.
• Keeping your heels together, open and close your legs like a clamshell.
• Perform up to 3 sets of 8 to 15 repetitions on the same side, then switch sides.

• Stand with legs shoulder-width apart and toes pointed forward, holding a table or counter for support. Position a chair behind you.
• Keeping your weight on your heels, slowly bend your knees while aiming your buttocks to the back of the chair as if you were going to sit. Bend your knees and hips equally until you are half way to the chair and hold that position momentarily. Don’t bend your knees past the point where you can no longer see your toes. . 
• Slowly return to the starting position and repeat 8 to 15 times, for up to 3 sets.

• Stand straight, facing and holding on to a kitchen counter or sturdy table top. If your balance is good, you can instead, stand with your hands on your waist.
• Raise your good leg, bending the knee as you move your foot backwards and upwards towards the buttocks, so that all your weight is on the affected hip.
• Slowly lower your good leg to the floor.
• Perform up to 3 sets of 8 to 15 repetitions on the same side, then switch sides.

• Sit in a steady chair and put a towel or resistance band around one foot, holding each end with your hands
• Sitting upright, straighten your knee against the band or towel
• Keep tension on the band or towel while controlling the return of the foot to a bent knee position
• After 8 to 15 repetitions, switch legs.

• Lying on your back, bend both knees and place feet flat on the ground or bed.
• Squeeze buttocks and lift your hips upwards and off the bed
• Pause briefly and slowly lower your hips back to the starting position
• Perform up to 3 sets of 8 to 15 repetitions

• Sit on the front edge of a chair with one knee bent and the foot flat on the floor
• Straighten the other leg by sliding the heel forwards on the floor
• Place both hands over the knee of the straight leg, bend at the hip by leaning forward and gently stretching the muscles in the back of the leg
• Hold for 30 to 45 seconds
• Slowly relax the stretch, and repeat on the other side
• Complete up to 3 times if you are stiff

• Sit with your back against the wall
• Bend one leg and loop a towel around the ankle of the bent leg
• Using the towel, gently pull the heel toward your buttocks
• Hold for a count of 15
• Release and repeat
• Complete up to 3 times if you are stiff